Combination bacteriolytic therapy for the treatment of tumors

ABSTRACT

Current approaches for treating cancer are limited, in part, by the inability of drugs to affect the poorly vascularized regions of tumors. We have found that spores of anaerobic bacteria in combination with agents which interact with microtubules can cause the destruction of both the vascular and avascular compartments of tumors. Two classes of microtubule inhibitors were found to exert markedly different effects. Some agents that inhibited microtubule synthesis, such as vinorelbine, caused rapid, massive hemorrhagic necrosis when used in combination with spores. In contrast, agents that stabilized microtubules, such as the taxane, docetaxel, resulted in slow tumor regressions that killed most neoplastic cells. Remaining cells in the poorly perfused regions of tumors could be eradicated by sporulated bacteria. Mechanistic studies showed that the microtubule destabilizers, but not the microtubule stabilizers, radically reduced blood flow to tumors, thereby enlarging the hypoxic niche in which spores could germinate. A single intravenous injection of spores plus selected microtubule-interacting agents was able to cause regressions of several tumors in the absence of excessive toxicity.

This invention was made using U.S. government support from NIH grant CA62924. The U.S. government therefore retains certain rights in theinvention.

TECHNICAL FIELD OF THE INVENTION

This invention is related to the field of oncology. In particular itrelates to combined biological and chemical treatments of tumors.

BACKGROUND OF THE INVENTION

The prognosis for patients who present with advanced cancers of thepancreas, colon, lung, breast, ovary, brain or prostate is dismal. Thistragic situation has stimulated an avalanche of research, resulting in arevolution in understanding cancer pathogenesis, significant gains inthe applications of conventional chemotherapeutic agents, and somepromising new agents. Unfortunately, this revolution has not yet had amajor impact on the treatment of common solid tumors. Many believe thatthe best hope for future therapeutic gains lies in combining novelapproaches with more conventional agents. Our laboratory has beenattempting to determine whether spores of C. novyi-NT, a strain ofanaerobic bacteria, can be used in such a fashion.

The rationale for using anaerobic bacteria lies in the unique angiogenicstate that exists within tumors. It is widely recognized that solidtumors require angiogenesis to grow to a clinically important size(Folkman, 2002; Kerbel, 2000). It is less often appreciated that solidtumors almost always outpace angiogenesis, often resulting in largeregions that are poorly vascularized (Brown, 2002). These poorlyperfused regions pose major problems for the oncologist. Drug deliveryis compromised and drug efficacy suffers not only from the lower drugconcentrations reached in avascular areas but also from the fact thatmany chemotherapeutic agents rely both on oxygen and on activelyreplicating tumor cells for full potency (Brown and Giaccia, 1998).

The potential of anaerobic bacteria for treating cancer was recognized ahalf century ago (Jain and Forbes, 2001). Though initial clinical trialsof such organisms were discouraging, this approach has more recentlybeen revisited using genetic engineering techniques not available in thepast (Heppner and Mose, 1978). For example, a strain of the facultativeanaerobe S. typhi was created in which the major endotoxin component wasmutated, resulting in a substantial diminution of toxicity (Low et al.,1999). Similarly, a cytosine deaminase gene was introduced into theanaerobe Clostridium sporogenes, endowing these bacteria with potentanti-tumor effects when used in combination with fluorocytosine, aprodrug activated by the introduced gene (Liu et al., 2002). Our grouphas eliminated the major systemic toxin gene from the strict anaerobe C.novyi, creating a strain called C. novyi-NT that had anti-neoplasticactivities when combined with selected chemotherapeutic agents (COBALT,for combination bacteriolytic therapy (Dang et al., 2001).

In a previous study of various chemotherapeutic agents theanti-microtubule agent dolastatin-10, was found to be particularlyeffective when used in combination with C. novyi-NT spores, thoughtoxicity was problematic (Dang et al., 2001). The mechanistic basis forthis efficacy was not known. There is a need in the art for a systematicexploration of the relationship between various anti-microtubule agentsand bacteriolytic therapy.

SUMMARY OF THE INVENTION

According to a first embodiment a method is provided for treating tumorsin a mammal. Spores of a toxin-defective anaerobic bacterium areadminstered to the mammal. A microtubule stabilizing anti-tumor agent isalso administered to the mammal. As a result of the treatment, the tumorregresses or its growth is slowed or arrested.

According to a second embodiment a kit for treating tumors is provided.The components of the kit are in a divided or undivided container. Thecomponents comprise spores of an anaerobic bacterium which istoxin-defective and an agent which stabilizes microtubules.

These and other embodiments of the invention which will be apparent tothose of skill in the art upon reading the specification provide the artwith an exciting modality for treating mammals including patients withtumors. These modalities cause striking tumor regressions withoutexcessive toxicity.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B Anatomic effects of drugs that destabilize microtubuleson HCT116 tumors

Photographs of mice bearing HCT116 xenografts after treatment on day 0with the microtubule destabilizers HTI-286 at 1.7 mg/kg (FIG. 1A) orvinorelbine at 20 mg/kg (FIG. 1B) with or without C. novyi-NT.

FIGS. 2A and 2B Anatomic effects of drugs that stabilize microtubules onHCT116 tumors

Photographs of mice bearing HCT116 xenografts after treatment on day 0with the microtubule stabilizing agents docetaxel at 50 mg/kg (FIG. 2A)or MAC-321 (FIG. 2B) at 60 mg/kg with or without C. novyi-NT.

FIGS. 3A through 3H Quantification of the effects of C. novyi-NT andHTI-286 in mice bearing various xenografts

Animals (n>6 for each arm) were treated with HTI-286+/−C. novyi-NTspores. The dose of HTI-286 (1.7 to 2 mg/kg) used to treat eachxenograft type was the smallest dose required to see significant effectswhen administered alone. Tumor growth curves (FIGS. 3A, 3C, 3E, and 3G)and progression free survival (Kaplan-Meier plots, FIGS. 3B, 3D, 3F, and3H) are shown. Light blue: untreated control; Purple: C. novyi-NT sporesalone; Green: drug alone: Red: drug plus C. novyi-NT spores. Thep-values are based on comparisons between drug alone and drug+C.novyi-NT spores. The p-value is indicated only when the result wasstatistically significant.

FIG. 4A-4D Anatomic effects of drugs that destabilize microtubules onvarious xenografts (CaPan-1, HuCC-T1, SW480, and HT-29, respectively)Photographs of mice bearing the indicated xenografts were treated withC. novyi-NT with HTI-286 and photographed 3 days later.

FIGS. 5A through 5D Quantification of the effects of C. novyi-NT andvinorelbine in mice bearing HCT116 or HT29 xenografts.

Animals (n>6 for each arm) were treated with vinorelbine (20 mg/kg)+/−C.novyi-NT spores. Tumor growth curves (FIGS. 5A and 5C) andprogression-free survival (FIGS. 5B and 5D) are shown. Color code sameas in FIGS. 3A through 3H. The p-values are based on comparisons betweendrug alone and drug+C. novyi-NT spores. The p-value is indicated onlywhen the result was statistically significant.

FIGS. 6A through 6F Quantification of the effects of C. novyi-NT anddocetaxel in mice bearing various xenografts.

Animals (n>5 for each arm) were treated with docetaxel+/−C. novyi-NT.The dose of docetaxel (50 to 75 mg/kg) was optimized for each xenografttype; for example, HT29 was less sensitive to docetaxel than the othertumor types. Tumor growth curves (FIGS. 6A, 6C and 6E) and progressionfree survival (Kaplan-Meier plots, FIGS. 6B, 6D and 6F) are shown. Colorcode same as in FIGS. 3A through 3H. The p-values are based oncomparisons between drug alone and drug+C. novyi-NT spores. The p-valueis indicated only when the result was statistically significant.

FIGS. 7A through 7F Quantification of the effects of C. novyi-NT andMAC-321 in mice bearing various xenografts.

Animals (n>6 for each arm) were treated with MAC-321+/−C. novyi-NT. Thedose of MAC-321 (45 to 70 mg/kg) was optimized for each xenograft type;for example, HuCC-T1 was more sensitive to MAC-321 than were the othertumor types. Tumor growth curves (FIGS. 7A, 7C and 7E) and progressionfree survival (Kaplan-Meier plots, FIGS. 7B, 7D and 7F) are shown. Colorcode same as in FIGS. 3A through 3H. The p-values are based oncomparisons between drug alone and drug+C. novyi-NT spores. The p-valueis indicated only when the result was statistically significant.

FIG. 8 Effect of docetaxel and HTI-286 on blood flow.

Mice bearing subcutaneous xenografts of HCT116 cells, 400-500 mm3 insize, were intravenously injected with HTI-286 (1.7 mg/kg) or docetaxel(50 mg/kg). Three or 24 hours after treatment, mice were intravenouslyinjected with Hoechst 33342 (40 mg/kg) and euthanized two minutes later.Tumors were cryosectioned and viewed by fluorescence microscopy aftercounter-staining with acridine orange (AO). Endothelial cells arestained blue when they have taken up the Hoechst 33342 dye. Adjacentsections were stained with MECA-32 monoclonal antibody, a vascularendothelium-specific marker. Arrows point towards normal blood vesselsunaffected by HTI-286 treatment in overlying skin.

FIGS. 9A through 9F Effect of docetaxel and HTI-286 on Glut-1expression.

Mice bearing subcutaneous xenografts of HCT116 cells, 400-500 mm3 insize, were intravenously injected with HTI-286 (1.7 mg/kg; FIGS. 9B, 9E)or docetaxel (50 mg/kg; FIGS. 9C, 9F). Mice were euthanized six hoursafter treatment. Tumors were sectioned and H & E stained. Adjacentsections were stained for Glut-1 expression, a marker for hypoxia. Cellspositive for Glut-1 appear brown. Arrows indicate examples ofhemorrhage.

FIG. 10A-10F Quantification of the effects of C. novyi-NT plus low dosesof HTI-286 and L-NNA on various xenografts (HCT116, HuCC-T1, HT-29,SW480, B16, and DLD-1, respectively).

Animals (n>6 for each arm) were treated with HTI-286 (1 mg/kg)+L-NNA (10mg/kg)+/−C. novyi-NT. HTI-286 at this dose had no significant effects ontumor growth when administered without L-NNA, and vice versa. Thep-values are based on comparisons between L-NNA+HTI-286 andL-NNA+HTI-286+C. novyi-NT spores. The p-value is indicated only when theresult was statistically significant.

FIG. 11 Chemical structures of paclitaxel, docetaxcel, and MAC-321.

FIG. 12 Chemical structures of HTI-286 and hemiasterlin.

DETAILED DESCRIPTION

The tumor microenvironment is heterogeneous. Oxygen concentrationswithin single tumors vary widely and can dramatically alter theresponses to therapies. We have targeted the poorly vascular regions oftumors with an anerobic bacterium and the vascular regions of tumorswith either microtubule stabilizing or destabilizing agents. We foundthat we could achieve major regressions and cures when these drugs werecombined with spores of anaerobic bacteria, but that the mechanismsunderlying the efficacy varied with the class of drug used. Specificagents that target different tumor microenvironments can be combined toproduce enhanced therapeutic results.

The bacteria useful in the practice of the present invention areanaerobic spore-formers. Suitable genera include but are not limited toBifidobacteria, Lactobacilli, and Clostridia. A number of species ofthese bacteria have been tested for their ability to grow in tumors in arobust and dispersed manner. Clostridium novyi and Clostridium sordeliiwere found to be the best of the strains we tested for these properties.Other strains and species having suitable characteristics can be used aswell.

Decreasing the natural production of toxins is desirable in usingbacteria therapeutically. While toxin-defective strains need not betotally non-toxigenic, it is desirable that at least one of the toxingenes by mutated, deleted, or otherwise inactivated to render thebacteria less harmful to the host. Preferably the toxicity is reduced bya factor of at least 2, 5, 10, 50, 100, or 1000. If a toxin gene isepisomal or on a phage, then curing of the episome or phage can be usedto delete the toxin gene. Techniques are well known in the art formutagenesis, curing, and screening of mutants.

Isolated and bacteriologically pure vegetative bacteria or spores,according to the invention are those which are not contaminated withother bacteria or spores. Microbiological techniques for obtaining suchpure cultures are will known in the art. Typically single colonies arepicked and spread upon an agar nutrient medium, separating colonies sothat new colonies arise that are the progeny of single cells. Thisprocess is typically repeated to ensure pure cultures. Alternatively,liquid cultures can be serially diluted and plated for single colonyformation. Serial repetition is desirable to ensure colony formationfrom single cells. See, e.g., J. H. Miller, Experiments in MolecularGenetics, Cold Spring Harbor Laboratory, NY, 1972.

Spores can be administered to a tumor-bearing mammal by any means whichwill afford access to the tumor. Spores can be injected intravenously,intradermally, subcutaneously, intramuscularly, intraperitoneally,intratumorally, intrathecally, surgically, etc. Preferred techniques areintravenous and intratumoral injections. Tumor bearing mammals can behumans, pets, such as dogs and cats, agricultural animals such as cows,sheep, horses, goats and pigs, and laboratory animals, such as rats,hamsters, monkeys, mice, and rabbits. The tumors to be treated arepreferably large enough to have outgrown their blood supply and containnecrotic regions. This factor should not be limiting for most humantumor situations, as the great majority of clinically apparent humantumors have large necrotic regions within them.

Combination treatment involves administering anaerobic spores as well asa second anti-tumor agent. Together these agents produce a greater ormore long-lasting decrease in the growth of the tumor. Second anti-tumoragents which can be used include any which are known in the art. Suchanti-tumor agents include but are not limited to agents which stabilizemicrotubules, agents which collapse tumor vasculature, typically byinhibiting synthesis of microtubules, radiation, and anti-tumor antigenantibodies. These anti-tumor agents are administered according to theconventional means used in the art of medical and radiation oncology.The agents can be administered in any order or simultaneously. It may bedesirable, however, to administer the spores prior to administering thesecond anti-tumor agent. If agents are to be administered serially, theyare preferably administered within a span of a month, more preferablywithin a span of a fortnight, and even more preferably within a span ofa week. Optimization of the time span is well within the skill of theart. Moreover, multiple anti-tumor agents can be administered inconjunction with the spores. Thus it may be desirable in order toachieve even greater reduction in tumor growth that a plurality ofanti-tumor agents be used. Anti-tumor agents from different categoriesor mechanisms may achieve superior results. Thus a preferred combinationincludes spores and a microtubule stabilizing agent.

Anti-tumor agents which stabilize microtubules include, but are notlimited to the taxanes, such as 10-deacetyltaxol;7-epi-10-deacetyltaxol; 7-xylosyl-10-deacetyltaxol; 7-epi-taxol;cephalomannine; baccatin III; baccatin V; 10-deacetylbaccatin III;7-epi-10-deacetylbaccatin III;2-debenzoyl-2-(p-trifluoromethylbenzoyl)taxol; and20-acetoxy-4-deacetyl-5-epi-20,O-secotaxol. Other microtubulestabilizers which can be used include arsenic trioxide, discodermolide,epothilone B, and (+)-14-normethyldiscodermolide.

Anti-tumor agents which function to collapse tumor vessels include butare not limited to vinblastine, vincristine, colchicine, combrestatinA4P, dolastatin-10, auristatin PE, auristatin PHE, D-24851, HTI-286,noscapine, vinorelbine, and 5,6 dimethylxanthenone-4-acetic acid. Othersas are known or discovered with the same function can be used. Suchagents are believed to function by inhibiting the synthesis ofmicrotubules.

Nitric oxide synthetase inhibitors, especially inhibitors of the eNOSisoform of the enzyme, can be used to potentiate the effects of themicrotubule-interacting drugs. Suitable inhibitors include but are notlimited to L-NNA, NG-monomethyl-L-arginine (L-NMMA), and L-NAME.

Kits comprising the useful components for practicing the anti-tumormethods of the present invention can be packaged in a divided orundivided container, such as a carton, bottle, ampule, tube, etc. Thespores and anti-tumor agents can be packaged in dried, lyophilized, orliquid form. Additional components provided can include vehicles forreconsititution of dried components. Preferably all such vehicles aresterile and apyrogenic so that they are suitable for injection into amammal without causing adverse reactions. The anti-tumor agents otherthan the spores are also preferably sterile. The spores are preferablymicrobiologically pure, i.e., containing no other bacteria other thanthe desired spore-forming anaerobe. Instructions for practicing themethod of the invention may be included in the kit, in paper orelectronic medium. A reference to a website that teaches the method mayalso be provided.

The above disclosure generally describes the present invention. A morecomplete understanding can be obtained by reference to the followingspecific examples which are provided herein for purposes of illustrationonly, and are not intended to limit the scope of the invention.

EXAMPLE 1 Materials & Methods

Drugs

Dolastatin 10, auristatin 15-PE, auristatin PYE, and pancratistatin7-O-phosphate were synthesized by Dr. G. R. Pettit (Cancer ResearchInstitute, Arizona State University, AZ) (Pettit, 1997). Discodermolide,(+)-14-normethyldiscodermolide synthesized by Dr. A. Smith (Universityof Pennsylvania, PA) (Smith et al., 2000). Epothilone B was synthesizedby S. Danishevsky, Memorial Sloan-Kettering Cancer Center, New York,N.Y. (Altmann, 2003). HTI-286[N,β,β-trimethyl-L-phenylalanyl-N¹-[(1S,2E)-3-carboxy-1-isopropylbut-2-enyl]-N¹,3-dimethyl-L-valinamide] was synthesized at Wyeth Research, Pearl River,N.Y. (Loganzo et al., 2003). MAC-321 [5β, 20-epoxy-1, 2α-, 4-, 7β-,10β-, 13α-hexahydroxytax-11-en-9-one 4 acetate 2 benzoate 7 propionate13-ester with (2R,3S)—N-tertbutoxycarbonyl-3-(2-furyl)isoserine](Sampath et al., 2003) was synthesized by Taxolog, Inc(Fairfield, N.J.). Combretastatin A4P and D-24851 were synthesized bySaeed Khan, Sidney-Kimmel Comprehensive Cancer Center, Baltimore, Md.Synthetic methods are cited in the references listed in Table 1.Vincristine, vinblastine, vinorelbine, paclitaxel, and docetaxel werepurchased from the Johns Hopkins Hospital Pharmacy. Colchicine,noscapine, arsenic trioxide, and L-NNA were purchased from Sigma (St.Louis, Mo.).

Cell Lines and Animals

Female athymic nude and C57BL/6 mice 6 to 8 weeks of age were purchasedfrom Harlan. HCT116, DLD1, SW480, HT29, LS174T, and CaPan-1 cells wereobtained from ATCC. HuCC-T1 cells were obtained from A. Maitra, JohnsHopkins Medical Institutions, Baltimore, Md. (Miyagiwa et al., 1989).HCT116 cells in which the p53 gene had been disrupted through homologousrecombination have been previously described (Bunz et al., 1998). Allcell lines were grown as monolayers in McCoy 5A medium (Gibco)supplemented with 5% fetal bovine serum at 37° C. and 5% CO2.

Tumorigenicity Assays

All animal protocols were designed in accordance with the Guide for theCare and Use of Laboratory Animals (NIH Publication 86-23) and wereapproved by the Johns Hopkins University Institutional Animal Care andUse Committee. Six to eight week old mice were implanted subcutaneouslyon one flank with 3 to 6 million cancer cells. Establishment of tumorsof 150 to 500 mm3 took 8 to 21 days, depending on the cell type. C.novyi-NT spores (300×106) and anti-microtubule agents were generallyadministered by a single intravenous injection through the tail vein ina total volume of 300 to 500 μl phosphate-buffered saline (PBS).Quantitative assessment of tumor growth was performed by measuringsubcutaneous tumor grafts (major and minor axis) using electroniccalipers. Tumor volume was calculated using the equation:length×width2×0.5. Progression free survival was defined as the lengthof time following treatment before any increase in tumor volume wasobserved. Mice were considered “cured” if no tumor was evident threemonths after treatment. Animals were weighed at least twice a week andcarefully observed for signs of toxicity every day for the first weekfollowing treatment and then twice a week thereafter. At least five micewere used for each treatment arm described in the Experimental Results.

Assessment of Blood Perfusion

Mice bearing HCT116 xenografts of 300 to 500 mm3 were injectedintravenously with anti-microtubule agents. At various times thereafter,they were intravenously injected with Hoechst 33342 (40 mg/kg), theneuthanized two minutes later by CO2 narcosis. Tumors were fixed inTissue-Tek OTC compound (Sakura Finetek, Torrance, Calif.) and stored at−80° C. Frozen sections 10 microns in thickness were prepared with aLeica Microsystems cryostat and counterstained with acridine orange, 7.5ug/ml, in PBS for 5 minutes. Adjacent sections were sequentiallyincubated with the MECA-32 monoclonal antibody (Pharmingen), abiotinylated anti-rat antibody (Jackson), and rhodamine-streptavidin(Vector). At least three sections of each of three tumors, representingmiddle and distal parts of the tumor, were examined under fluorescencemicroscopy for each agent tested, and representative results areillustrated in the figures.

Immunohistochemistry

Paraffin sections were deparaffinized, incubated with proteinase K(Invitrogen), heated at 95° C. for 20 min in citrate buffer (pH 6), andtreated with peroxidase blocking reagent (Dako). Sections were incubatedwith a monoclonal antibody against Glucose Transporter-1 (Glut-1, Dako)followed by a biotin-conjugated secondary antibody (Pierce). A thirdlayer consisting of HRP-conjugated anti-biotin (DAKO) was followed bydiaminobenzidine (Sigma) staining. Sections were counterstained witheosin.

Quantification of C. novyi-NT in Tumors

Mice bearing HCT116 xenografts were treated with C. novyi-NT spores withor without HTI-286 (1.7 mg/kg) as described above. Following euthanasia24-48 hr later, tumors were harvested, weighed, minced, andDounce-homogenized. Genomic DNA was isolated using the Qiagen GenomicDNA Buffer Set and Genomic-tip 100/G. 25 ng of DNA was used in a PCRusing the conditions described in (Vogelstein and Kinzler, 1999) Thefollowing primers specific for the C. novyi-NT phospholipase C gene wereused: 5′-AAGATGGTACAGGA ACTCATTCC (SEQ ID NO:1) and5′-GCTTGTCCGAAATACCATGTTGC (SEQ ID NO:2). No detectable primer dimersformed and no nonspecific amplification of mouse or xenograft genomicDNA occurred with these primers and PCR conditions. Real-time PCR wasperformed using an iCycler, and threshold cycle numbers were calculatedusing the iCycler Optical system interface software (Bio-Rad Lab,Hercules, Calif.). Averages of the threshold cycle number (Ct) oftriplicate measurements per tumor were obtained, and three differenttumors were studied for each treatment group. The results were expressedas the difference between the Ct of the treated tumor and the Ct ofuntreated controls, normalized to tumor weight.

Statistical Analysis

Progression-free survival across treatment groups was compared usingKaplan-Meier curves. Significance of differences was assessed using thelog-rank test. Longitudinal data about tumor sizes was analyzed in twostages. First, for each animal i, we fit a regression equation of theform log(1+yit)=a+bi t, where t is time and yit is the tumor volume ofanimal i at time t, relative to the tumor volume of the same animal attime 0. The p-values were determined using a student t-test on theexponential regression slope for each individual mouse. This approachwas motivated by the need to account for within-animal correlations intumor-volume measurements, as described in Section 6.3 of (Diggle P J,1994). The fit of the animal specific regressions was generally good,with R-squared values ranging from 0.99 to 0.80.

EXAMPLE 2 Comparison of Microtubule-Interacting Chemotherapeutic Agents

The timing, route, and dose of agents are critical for the success ofany experimental therapy. When two agents are combined, the number ofvariables that must be tested increases exponentially. To simplifyinterpretation of the comparisons between various anti-microtubuleagents, pilot studies with representative drugs were performed. Based onthe optima found through these pilots, the following protocol wasimplemented: (i) several doses of each chemotherapeutic agent weretested, up to a maximum of the LD50; (ii) the dose of C. novyi-NT was3×108 spores; and (iii) the chemotherapeutic agents and bacterial sporeswere mixed in a total volume of 300 to 500 μl and injectedintravenously. This joint administration was selected for convenience,as it was found that administration of representative chemotherapeuticagents within several hours before or after the administration ofbacterial spores was as efficacious as administering the spores anddrugs together.

Eighteen agents known to interact with microtubules were each tested inthis manner in nude mice harboring xenografts of HCT116 human colorectalcancer cells. At least five mice harboring tumors of 150 to 500 mm3 insize were used for each experimental arm. Table 1 lists the agentstested, the doses, and the results obtained. Two classes of responseswere noted. One type of response was characterized by a rapidhemorrhagic necrosis, observed only with agents that inhibitedmicrotubule synthesis (FIG. 1A, B). The other type of response wascharacterized by a slow regression, observed with agents that stabilizedmicrotubules (FIG. 2A, B). The two most promising agents from eachclass, based on efficacy and toxicity, were chosen for further study:these were the microtubule destabilizers HTI-286 and vinorelbine and themicrotubule stabilizers docetaxel and MAC-321.

TABLE 1 Microtubule-interacting agents Effect Effect Agent Dose* (route)alone** with C. novyi-NT* Reference Microtubule stabilizers arsenictrioxide 10 mg/kg × 1 (ip) 0 + Griffin, 2000 discodermolide 20 mg/kg × 1(iv) ++ ++++ ter Haar, 1996 15 mg/kg × 1 (iv) ++ ++++ docetaxel 75 mg/kg× 1 (iv) +++ ++++ Rowinsky, 1997 50 mg/kg × 1 (iv) ++++ ++++ 25 mg/kg ×1 (iv) ++ +++ 12.5 mg/kg × 1 (iv) + ++ epothilone B 25 mg/kg QD × 4 (ip)NT + Bollag, 1995 (+)-14-normethyldiscodermolide 15 mg/kg × 1 (iv) + +Martello, 2001 paclitaxel 30 mg/kg × 1 (iv) 0 + Rowinsky, 1997 15 mg/kg× 1 (iv) 0 0 MAC-321 70 mg/kg × 1 (iv) +++ ++++ Sampath, 2003 60 mg/kg ×1 (iv) +++ ++++ 50 mg/kg × 1 (iv) +++ ++++ 45 mg/kg × 1 (iv) +++ ++++ 10mg/kg × 1 (iv) + ++ Microtubule destabilizers auristatin PE 2 mg/kg × 1(iv) 0 + Pettit, 1995 auristatin PHE 0.2 mg/kg × 1 (iv) 0 + Woyke, 2001colchicine 20 mg/kg × 1 (ip) ++ ++ Baguley, 1991 5 mg/kg × 1 (ip) + + 10mg/kg × 1 (ip) + + combretastatin A4P 200 mg/kg × 1 (ip) + + Tozer, 200250 mg/kg × 1 (ip) 0 + D-24851 100 mg/kg × 1 (ip) 0 + Bacher, 2001 25mg/kg × 1 (ip) 0 + Dolastatin 10 0.45 mg/kg × 1 (iv) 0 +++ Chaplin, 19960.30 mg/kg × 1 (iv) 0 +++ HTI-286 2.0 mg/kg × 1 (iv) ++ ++++ Loganzo,2003 1.9 mg/kg × 1 (iv) ++ ++++ 1.7 mg/kg × 1 (iv) + ++++ 1.5 mg/kg × 1(iv) + ++ 1.0 mg/kg × 1 (iv) 0 + 0.5 mg/kg × 1 (iv) 0 + noscapine 70mg/kg × 1 (iv) 0 + Landen, 2002 50 mg/kg × 1 (iv) 0 + vincristine 10mg/kg × 1 (ip) 0 + Baguley, 1991 5 mg/kg × 1 (ip) 0 0 vinblastine 10mg/kg × 1 (ip) + + Baguley, 1991 5 mg/kg × 1 (ip) 0 0 vinorelbine 24mg/kg × 1 (iv) + +++ Holwell, 2001 20 mg/kg × 1 (iv) + +++ 16 mg/kg × 1(iv) + ++ *only doses below the LD50 are shown **NT: not tested; 0: noresponse; +: inhibition of tumor growth but no tumor shrinkage; ++: 10%to 50% shrinkage in tumor volume relative to pre-treatment size;+++: >50% shrinkage in tumor volume relative to pre-treatment size;++++: >20% cures

COBALT/HTI-286. A modest amount of hemorrhagic necrosis was observedfollowing administration of HTI-286 to mice bearing HCT116 xenografts,but this necrosis was dramatically enhanced by co-administration of C.novyi-NT spores (FIG. 1A). This response translated into prolongedgrowth inhibition (FIG. 3A) and substantial increases in time toprogression (FIG. 3B).

We next evaluated the responses to COBALT/HTI-286 in other murine tumormodels. There was a striking similarity in the initial responses toCOBALT/HTI-286 in all models tested, including the DLD1, SW480, LS174T,HT29, and HCT116-p53−/− colorectal cancers, the HuCC-T1cholangiocarcinoma, the CaPan-1 pancreatic cancer and the B16 melanoma.All models were human tumor cell lines xenografted into nude mice withthe exception of B16, which was a murine cell line transplanted intosyngeneic mice. All underwent hemorrhagic necrosis within 2 or 3 days oftreatment (examples in FIG. 4A to D), resulting in tumor shrinkage(examples in FIGS. 3C, E, and G). There was much more variability,however, in the responses over the long term. In some cases, such asHCT116 and HuCC-T1, approximately 40% of mice were cured by a singleintravenous injection of C. novyi-NT plus HTI-286 (FIGS. 3B and D,respectively). In other cases, such as HT29 and CaPan-1, cures wereobserved in <10% of mice (FIGS. 3F and H). The other tumor modelsresponded at a level intermediate to that of HCT116 and HT29. It isimportant to note that in all cases the addition of C. novyi-NT resultedin an improvement over the responses obtained with HTI-286 alone. It wasalso notable that the p53 status of tumors, which often appears tomodify therapeutic effects (Pirollo et al., 2000), had little influenceon the efficacy of COBALT/HTI-286. The most direct demonstration of thiswas provided by treatment of xenografts derived from HCT116 cells inwhich the p53 gene was purposefully disrupted by gene targeting (Bunz etal., 1998); the results were very similar to those shown in FIGS. 3A andB for parental HCT116 cells, with 38% of the mice cured of their p53−/−tumors.

COBALT/vinorelbine. Vinorelbine is a clinically approved drug that, likeHTI-286, inhibits microtubule synthesis and thereby disruptsmicrotubules. Two tumor xenograft models, one (HCT116) relativelysensitive to COBALT/HTI-286 and one (HT29) relatively resistant toCOBALT/HTI-286 were chosen to evaluate COBALT/vinorelbine.COBALT/vinorelbine also induced hemorrhagic necrosis, though thisnecrosis was less pronounced than that obtained with COBALT/HTI-286(compare FIG. 1B with FIG. 1A). As with COBALT/HTI-286, HCT116 respondedmuch better to COBALT/vinorelbine than did HT29 (FIG. 5).

COBALT/docetaxel and COBALT/MAC-321. As noted above, a very differenttype of response was observed with C. novyi-NT when used in combinationwith microtubule stabilizing drugs, exemplified by docetaxel andMAC-321. In particular, there was a much slower response and nohemorrhagic necrosis following COBALT with these agents (FIG. 2).Additionally, the tumors generally underwent a more pronouncedregression with docetaxel or MAC-321 alone than with HTI-286 orvinorelbine alone. Nevertheless, the addition of C. novyi-NT sporessubstantially improved the durations of the remissions achieved withthese agents. All mice bearing HCT116 xenografts treated withCOBALT/docetaxel were cured, unlike the case with docetaxel alone (FIG.6A, B). The responses of mice bearing HuCC-T1 were also encouraging(FIG. 6 C, D). Like the case with COBALT/HTI-286, HT29 did not respondnearly as well as the other two tumor types tested (FIG. 6E, F). HCT116cells with genetically disrupted p53 genes also responded toCOBALT/docetaxel, with complete regressions in all mice and cures in44%, whereas docetaxel alone cured only 13% of the mice.

The responses of HCT116 tumors to COBALT/MAC-321 were very similar tothose of COBALT/docetaxel, as would have been predicted from theirstructural similarity. The three xenograft types tested underwent majorregressions, with cures achieved in a substantial fraction of two ofthem (FIG. 7). Though the initial tumor regressions were no moreimpressive with MAC-321 plus C. novyi-NT than with MAC-321 alone, theduration of the responses was markedly different when C. novyi-NT wasadded. Four of seven mice harboring HuCC-T1 xenografts were curedfollowing C. novyi-NT plus MAC-321 treatment, whereas only one of eightmice treated with MAC-321 alone was cured (p<0.05; FIG. 7D). Similarly,all mice bearing HCT116 xenografts were cured following COBALT/MAC-321while no mice treated with the MAC-321 alone were cured (p<0.0001 FIG.7B).

EXAMPLE 3 Mechanisms Underlying the Two Classes of Responses

We sought to determine the basis for the differences in responsesobserved with the two classes of microtubule-interacting drugs,represented by HTI-286 and docetaxel, when used in conjunction with C.novyi-NT. It has previously been shown that some microtubule-interactingdrugs, particularly those that inhibit microtubule synthesis such asDMXAA and combretastatin A4P, inhibit tumor blood flow (Baguley, 2003)(Tozer et al., 2002). To test whether HTI-286 and docetaxel affectedblood flow, we treated HCT116 tumor-bearing mice with these drugs, thenintravenously injected the cell-permeable DNA-binding dye Hoechst 33342two minutes prior to sacrifice. Hoechst predominantly labels the nucleiof endothelial cells in such experiments, as the dye does not have timeto diffuse through the tissue during the interval between injection andsacrifice (Bernsen et al., 1999). Frozen sections of the tumors revealedthat blood flow to the tumors was almost completely inhibited byHTI-286, a microtubule destabilizer, by 3 hr and that this inhibitionremained for at least 24 hr (FIG. 8). In contrast, docetaxel, amicrotubule stabilizer, had no observable effects on blood flow (FIG.8). The effect of HTI-286 on blood flow was tumor-specific in thatHoechst staining of the blood vessels in the skin overlying the tumorswas not affected (e.g., arrows in 3 and 24 hr time points in FIG. 8).Staining adjacent sections with the endothelial specific antibody MECA32revealed that endothelial cells were still present after treatment withHTI-286 but they were not being perfused with the Hoechst dye dissolvedin the blood. Many of them looked abnormal, with few of the longcontinuous vessels that were evident in controls or in animals treatedwith docetaxel.

These results suggested that treatment with microtubule destabilizersincreased the extent of hypoxia within tumors by inhibiting blood flow,thereby creating a larger niche for the anaerobic bacteria to populate.Two independent tests of this hypothesis were performed. First, wedirectly assessed hypoxia within tumors by staining with an antibody toGlucose Transporter-1 (Glut-1). Glut-1 has been extensively studied andshown to be specifically expressed only in hypoxic regions (Airley etal., 2001). Tumors treated with HTI-286 expressed large amounts ofGlut-1 within 6 hr of treatment (FIG. 9E). Small lakes of erythrocytes,indicating static blood flow, were observed in adjacent sections, and noevidence of tumor cell death was observed at these early time pointsafter HTI-286 treatment (FIG. 9B). No increase of Glut-1 staining wasfound in tumors treated with docetaxel (FIG. 9F) compared to untreatedtumors (FIG. 9D).

Second, we directly tested the size of bacterial populations withintumors by measuring the number of bacteria at various times followingintravenous injection of C. novyi-NT spores into mice bearing HCT116xenografts. Because of the exquisite sensitivity of these bacteria tooxygen, it was difficult to reliably assess the number of bacteria intumors through conventional microbiologic evaluation, and we chose touse quantitative PCR methods for this purpose. Using primers specificfor the phospholipase C gene of C. novyi-NT (Tsutsui et al., 1995), wefound that these bacteria accumulated to a level of 4.8×108 bacteria pergram of tumor (range 2.2 to 8.1×108) after 24 hours when administeredwithout chemotherapeutic drugs. When co-injected with HTI-286, thenumber of bacteria increased by 6.8-fold+/−0.08 (standard deviation). Incontrast, when co-administered with docetaxel, the number of bacteriaincreased by only 1.6-fold+/−0.3 (standard deviation).

EXAMPLE 4 Lowering the Dose of Microtubule Destabilizers

Clinical trials of microtubule destabilizers have often beendisappointing in that the maximum tolerated dose (MTD) was reachedbefore any anti-vascular effects were observed. A recent study has shownthat the dose of the microtubule destabilizers combretastatin A4P couldbe reduced when nitric oxide synthesis (NOS) inhibitors wereconcurrently administered (Parkins et al., 2000). This strategy wasbased on the observation that the vascular relaxing compound NO isreleased from some tumor cells in the presence of vascular injury andcould thereby combating the effects of the combretastatin A4P on tumorblood flow (Parkins et al., 2000). In view of the anti-vascular actionof HTI-286 described above, we tested whether this concept could beapplied to treatment with HTI-286. We administered a well-tolerated doseof the NOS inhibitor L-NNA together with varying doses of HTI-286 tomice bearing HCT116 xenografts. We found that L-NNA added little to theeffects observed with either C. novyi-NT alone or high doses of HTI-286plus C. novyi-NT, when vascular shut-down was already complete. However,L-NNA significantly enhanced the responses to low doses of HTI-286without adding toxicity. The response was enhanced further when L-NNAand low doses of HTI-286 were used in combination with C. novyi-NT (FIG.10A). Marked hemorrhagic necrosis was observed, similar to that shown inFIG. 1, while little hemorrhagic necrosis was observed when any one ofthe three components (L-NNA, HTI-286 at 1 mg/kg, or C. novyi-NT spores)were left out. C. novyi-NT was able to substantially improve thetherapeutic effects of treatment with L-NNA plus low doses of HTI-286 inHuCC-T1, SW480, and B16 tumors, but had only small effects in HT29 andDLD-1 cells (examples in FIGS. 10B-F).

EXAMPLE 5 Toxicity of COBALT

In our previous study of C. novyi-NT plus dolastatin-10 and mitomycin C,toxicity was of particular concern, as up to 30% of the mice with tumorsdied from the treatment. This toxicity was observed only when thecombination of C. novyi-NT spores and the drugs was administered and notwith either the bacteria or the drugs alone. The new combinationsdescribed in the current study proved to be significantly less toxic. Atotal of >600 nude mice bearing relatively large xenografts were treatedwith C. novyi-NT in combination with HTI-286, vinorelbine, docetaxel, orMAC-321. Though major tumor regressions were common, few mice died as aresult of therapy (Table 2) No deaths occurred after treatment with themicrotubule stabilizers plus C. novyi-NT, while 4% to 8% of mice treatedwith microtubule destabilizers plus C. novyi-NT died. The only othertoxicity observed was transient weight loss (Table 3). Mice treated withthe drugs alone lost ˜5 to 10% of their body weight within 7 days, whileweight loss after treatment with C. novyi-NT plus these drugs variedfrom 8% to 18%. All weights recovered to pre-treatment levels within twoweeks.

TABLE 2 Mortality following COBALT Drug dose # dead Treatment (mg/kg) #mice (%)* No treatment control — 110 0 C. novyi-NT spores — 118 0docetaxel 25.0 5 0 50.0 43 0 75.0 34 0 C. novyi-NT + docetaxel 25.0 5 050.0 45 0 75.0 33 0 MAC-321 45.0 28 0 50.0 9 0 60.0 23 0 70.0 9 0 C.novyi-NT + MAC-321 45.0 32 0 50.0 9 0 60.0 23 0 70.0 9 0 vinorelbine16.0 16 0 20.0 12 0 24.0 12 0 C. novyi-NT + vinorelbine 16.0 26 0 20.015 1 (6.7%) 24.0 12 0 HTI-286 1.7 104 3 (2.9%) 1.9 55 3 (5.4%) 2.0 47  5(10.6%) C. novyi-NT + HTI-286 1.7 127 10 (7.9%)  1.9 98 4 (4.1%) 2.0 1888 (4.3%) *Treatment-related deaths (i.e., those that occurred within oneweek of the initiation of therapy) were determined from experiments withHCT116, HT29, DLD1, SW480, Capan-1 and HuCC-T1 xenografts.

TABLE 3 Weight loss after COBALT Drug dose Weight Treatment (mg/kg) #mice Loss (%)* No treatment control — 39 0.0 C. novyi-NT spores — 8 5.5docetaxel 50.0 8 11.0 C. novyi-NT + docetaxel 50.0 9 12.0 MAC-321 60.0 85.5 C. novyi-NT + MAC-321 60.0 7 10.2 vinorelbine 24.0 6 8.3 C.novyi-NT + vinorelbine 24.0 6 8.3 HTI-286 1.7 6 11.4 C. novyi-NT +HTI-286 1.7 6 18.3 *Weight loss was determined from experiments withHCT116 xenografts. The maximum average weight loss relative to theweight one day prior to treatment is indicated.

The results described above show that C. novyi-NT, when combined withspecific microtubule-interacting drugs, can have dramatic effects onexperimental tumors. Hemorrhagic necrosis following COBALT/microtubuledestabilizers was observed in all nine tumor models tested. C. novyi-NTwas also found to cooperate with microtubule stabilizing agents,converting the transient tumor regressions obtained with the drugs aloneto cures in the most sensitive models. It was notable that theseresponses were observed after only a single dose of C. novyi-NT sporesplus drugs.

Several intriguing questions are raised by these data. The first relatesto the markedly different effects of microtubule stabilizers andmicrotubule destabilizers. Microtubule stabilizers like docetaxel andMAC-321 had substantial anti-tumor effects on their own, but rarelyproduced cures when administered only once. From the results presentedin this paper, we surmise that these drugs leave foci of tumor cells inpoorly perfused regions of the tumors, either because adequateconcentrations of drugs are not reached in these regions or because thetumor cells there are not replicating and are therefore not assusceptible to the cytocidal activities of these agents. Because C.novyi-NT specifically targets the hypoxic areas least likely to bekilled by these agents, it is not surprising that the spores cancooperate with them. Though delivery of spores to the poorly perfusedareas of tumors may be relatively low, it presumably only requires oneor a few spores to reach such areas. With a doubling time of 45 minutes,the C. novyi-NT can rapidly proliferate, and as shown previously (Danget al., 2001), the germinated bacteria have the capacity to killsurrounding tumor cells, stopping only when they reach thewell-oxygenated regions.

In contrast, microtubule destabilizers appear to disrupt blood flowwithin the tumors, presumably because the microtubule networks invascular endothelial cells or perivascular smooth muscle cells arespecifically sensitive to such disruption (Griggs et al., 2001). Thoughthe basis for this differential sensitivity is not understood, it isclear that many microtubule destabilizing agents have similar effects ontumor vasculature, rapidly stopping blood flow to the tumor (Griggs etal., 2001). HTI-286 is a novel anti-microtubule destabilizer that bindsα-tubulin at the vinca-peptide binding site, unlike classic agents suchas colchicine or combretastatin A4 (Hamel and Covell, 2002). BecauseHTI-286 stops blood flow without destroying endothelial cells, much likethese previously studied agents, it is clear that the disruption ofmicrotubules per se, rather than the way in which the drug binds tomicrotubules, is critical for this activity. Based on theseobservations, we conclude that the efficacy of COBALT/HTI-286 is in partdue to the ability of the drugs to decrease blood flow and therebycreate larger regions of hypoxia for the spores to germinate andmultiply. This conclusion is consistent with the demonstration thatthere were far greater numbers of bacteria in tumors treated withCOBALT/HTI-286 than with C. novyi-NT alone.

Several other practical points emerged from our study. Toxicity isalways a serious issue when dealing with biologic agents that arecapable of self-replicating. In our initial studies with C. novyi-NT,both dolastatin-10 and mitomycin C were required to achieve pronouncedeffects, and this triple combination was toxic, killing up to a third ofthe animals (Dang et al., 2001). The new combinations, generallyemploying only a single agent in combination with C. novyi-NT, hadacceptable toxicities (Tables 2 and 3). Importantly, no deaths wereobserved in animals treated with C. novyi-NT alone, COBALT/docetaxel orCOBALT/MAC-321 (Table 2), despite the substantial cure rates achievedwhen using either combination (FIGS. 6, 7). The basis for the smallnumber of deaths that occurred after COBALT/HTI-286 orCOBALT/vinorelbine is unclear. Deaths were a bit more common in verylarge tumors (>650 mm3) than in tumors of small or intermediate size.This suggests that tumor lysis syndrome, sepsis, or release of toxicproducts from the tumors plays a role in the toxicity of COBALT/HTI-286,each of which can be expected to be greater in larger tumors. Detailednecropsy studies of animals that died after COBALT/HTI-286 have notrevealed any specific abnormalities that would point to a specific causeof death.

Another issue that has been raised with regard to anaerobicbacteriolytic therapies concerns the size of tumors that can besuccessfully treated. Smaller tumors are expected to have a smallerfraction of necrosis and hypoxia, thereby limiting the potential ofanaerobic bacteria to proliferate. The results obtained in the currentstudy suggest that this may not be as much of a problem as anticipated.Though reduced efficacy was observed with HCT116 tumors of <100 mm3 insize compared to larger tumors, complete regressions were achieved withtumors as small as 100 mm3, 250 mm3 and 150 mm3 after COBALT/HTI-286,COBALT/docetaxel, and COBALT/MAC-321, respectively, while suchregressions were not seen after administration of the same drugs in theabsence of C. novyi-NT spores.

There were other encouraging findings in this study that may beapplicable to the planning of future clinical trials. The effective doserange of C. novyi-NT was very wide. Though we chose to administer 3×108spores per mouse, we found that 100-fold lower doses (3×106)induced >90% shrinkage of HCT116 tumors when given together with thestandard dose of HTI-286 (unpublished data). The relatively low toxicityand the ability of C. novyi-NT spores to enhance the effects of severalanti-microtubule agents with different mechanisms of action in severaldifferent tumor models also bodes well for future clinical application.

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The invention claimed is:
 1. A method for treating a tumor containingone or more poorly vascularized regions in a mammal comprising:administering to the mammal spores of a toxin-defective, anaerobicbacterium selected from the group consisting of Clostridium novyi andClostridium sordellii; and administering to the mammal one or moretaxane microtubule stabilizing anti-tumor agents; whereby the tumorregresses or its growth is slowed or arrested.
 2. The method of claim 1wherein the anaerobic bacterium is Clostridium novyi.
 3. The method ofclaim 1 wherein the anaerobic bacterium is Clostridium sordellii.
 4. Themethod of claim 1 wherein the spores are administered intravenously. 5.The method of claim 1 wherein the spores are administeredintratumorally.
 6. The method of claim 1 wherein all or part of a toxingene of a wild type form of the anaerobic bacterium is deleted.
 7. Themethod of claim 1 wherein the one or more taxanes are selected from thegroup consisting of taxol, taxotere and MAC-321.
 8. The method of claim7 wherein one of the one or more taxanes is taxotere.
 9. The method ofclaim 7 wherein one of the one or more taxanes is MAC-321.
 10. Themethod of claim 1 further comprising: administering a nitric oxidesynthetase (NOS) inhibitor to the mammal.
 11. The method of claim 1wherein the spores and anti-tumor agent are administered serially. 12.The method of claim 10 wherein the spores, anti-tumor agent and NOSinhibitor are administered serially.